Division of Paediatric Nephrology, Rainbow Children Hospital, Bangalore, India.
Pediatr Transplant. 2021 Nov;25(7):e14064. doi: 10.1111/petr.14064. Epub 2021 May 31.
Immunoadsorption (IA) plasmapheresis is standard modality for pretransplant desensitization in ABO-incompatible solid organ transplants though technically challenging when considered for an infant or a child less than 10 kg due to non-availability of pediatric immunoadsorption (IA) columns. The major challenge is to maintain hemodynamic stability considering the large extracorporeal circuit volume meant for adults. To our best knowledge after extensive search in acclaimed global medical journals, this is the first successful attempt in an underweight (6 kg) infant of less than 1 year of age using adult size IA Column thus making it a reality.
We report an 8-month-old male infant (A positive) of 6 kg with decompensated liver disease secondary to extrahepatic biliary atresia requiring urgent live donor liver transplantation with AB positive donor with significantly elevated pretransplant anti-B IgG/ IgM antibody titers >1:1024. Baby underwent multiple sessions of anti-B immunoadsorption plasmapheresis to lower anti-B IgM / IgG titers using available adult anti-B immunoadsorption column. Postprocedure, the antibody titers reduced to 1:8 (anti-IgG) 1:16 (anti-IgM) followed by successful ABO-incompatible live donor liver transplant (LDLT).
Anti-B titers remained in normal range in the immediate and post-transplant period with satisfactory liver functions and no rejection.
Immunoadsorption plasmapheresis for ABO-incompatible solid organ transplantation in infants gives desirable results and can be offered to small sized infants using currently available adult sized IA columns when conducted with adequate technical expertise.
免疫吸附（IA）血浆置换是 ABO 不相容实体器官移植中进行移植前脱敏的标准方式，但是由于缺乏儿科免疫吸附（IA）柱，对于 10 公斤以下的婴儿或儿童，考虑到技术上的挑战，该方法并不适用。主要的挑战是考虑到成人使用的大型体外回路体积，维持血液动力学稳定。据我们所知，在广泛搜索著名的全球医学期刊后，这是首例在体重不足（6 公斤）、不到 1 岁的婴儿中使用成人大小的 IA 柱进行的成功尝试，这使其成为现实。
我们报告了一例 8 个月大的男性婴儿（A 阳性），体重 6 公斤，患有失代偿性肝病，继发于肝外胆管闭锁，需要紧急进行活体供肝移植，供肝为 AB 阳性，移植前抗-B IgG/IgM 抗体滴度显著升高，>1:1024。婴儿接受了多次抗-B 免疫吸附血浆置换，以使用现有的成人抗-B 免疫吸附柱降低抗-B IgM/IgG 滴度。手术后，抗体滴度降至 1:8（抗-IgG）和 1:16（抗-IgM），随后成功进行了 ABO 不相容的活体供肝移植（LDLT）。
在即刻和移植后期间，抗-B 滴度保持在正常范围内，肝功能良好，无排斥反应。
IA 血浆置换在婴儿中的 ABO 不相容实体器官移植中可获得理想的结果，并且当使用目前可用的成人大小的 IA 柱时，可以为较小的婴儿提供，只要具备足够的技术专业知识。
